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<br /> <br />ADDITION/DELETION FORM FOR AUTHORIZED REPRESENTATIVES <br /> <br />LOCATION NUMBER: 25508 <br /> <br />EFFECTIVE DATE: 10- C( - 2C(;l? <br /> <br />PARTICIPANT NAME: City of La Porte <br /> <br />PART I: DELETIONS - Please enter the names of the individual(s) to be <br />Representatives. <br /> <br /> <br />as Authorized <br /> <br />PRINTED NAME PRINTED NAME <br />I <br /> <br />1. Cynthia Alexander <br /> <br />3. <br /> <br />Inquiry Only Representative* <br /> <br />2. Lori Langelier <br /> <br />PART II: ADDITIONS - Please enter the names of the individual(s) to be <br />Representatives. <br /> <br /> <br />as Authorized <br /> <br />PRINTED NAME TITLE SIGNATURE <br /> <br />Phyllis Rinehart <br /> <br />Controller <br /> <br />at:P~c;t;Jzcu,j <br /> <br />PART III: APPROVALS - Please enter the names of ai/individuals who are currently Authorized <br />Representatives and who authorize the deletions and additions of the individuals above. <br /> <br /> <br />Michael Dolby <br /> <br />Interim Director of Finance <br /> <br />Shelley Wolny <br /> <br />Budget/Investment Officer <br /> <br />Page 1 <br />